You Can Have Pelvic Issues at Any Age
- ocherie
- Apr 6
- 7 min read
Updated: Apr 7
There is a common train of thought that my patients bring up from time to time. Sometimes they bring it up on the first day during their initial evaluation, and sometimes they bring it up on later visits, whether directly or indirectly.
"I know this is happening because I'm getting older."
"I don't know why this is happening, I'm not that old!"
"I don't want to pee myself like my grandma did."
You don't know what you don't know, and this stuff is rarely talked about, both among friends/family or with a patient's provider. People may even think they're the only ones going through this issue and/or there's nothing to be done for it. Either way, many people assume it's age related, specifically something older people go through. That this is as immutable as the tides themselves.
Not quite! Pelvic floor dysfunction (PFD) can happen at any age.
Age as a direct correlation to PFD is a myth on a few different levels. The first is defining what PFD means to people because, as stated from my previous post, pelvic health physical therapists treat a variety of conditions. Most people think of peeing in their pants, but I've had patients believe their pelvic organ prolapses were just another characteristic of getting older.
While age is a risk factor, it is not a guarantee of PFD nor of its severity. 40% of women worldwide experience having a prolapse. From here, the statistics for age gets a little less precise.
Per Wang et al., "the proportion of women aged 70-79 seeking medical consultation due to symptomatic POP is the highest, as high as 18.6/1,000" with the "annual incidence rate of POP is 1.5-1.8/1,000 and the highest incidence rate is among women aged 60-69." And yet, while increased age is a confirmed risk factor for developing a prolapse, younger age was a significant risk factor for a prolapse to reoccur.
When it comes to incontinence, the numbers vary as well. In a Vital and Health Statistics report from the CDC in June 2014 for Prevalence of Incontinence Among OIder Americans, they based their 2,625 noninstitutionalized population on face-to-face interviews from 2007-2010. The report also has data from residential care facility residents in 2010, home health and hospice care patients in 2007, and nursing home residents in 2009. The report includes not just percentage of urinary leakage, but also bowel leakage as well. The outcome measure used was the bladder incontinence severity index (ISI), which is based on two questions: "How often do you have urinary leakage?" and "How much urine do you lose each time?"
The results from all of these populations? Within the noninstitutionalized population aged 65 years and older, 50.9% reported urinary leakage and/or bowel leakage, with 43.8% of those people reporting urinary leakage. The severity of their leakage differed as about 12% of women had severe or very severe ISI scores of bladder incontinence. What kind of leakage did the rest of the women and almost all of the men report? They reported slight or moderate ISI scores. So what does that mean? Even among those who are 65 years and older, there was no guarantee of severity, as most of the people had slight or moderate leakage.
Pelvic health not only treats adults, but children and teenagers as well. "As many as 1 in 7 school-aged children" deal with incontinence issues. There is a prevalence of 35% of female athletes with urinary incontinence practicing different sports, with the average age of the female athletes at 23.8 years.
Age is just one risk factor, so what are the other risk factors for urinary incontinence and prolapses? When it comes to risk factors, there are two types: modifiable and non-modifiable. One type of risk factors can be modified by an individual while the other type you can't.
Schulten et al. noted that primary prolapse risk factors are "vaginal delivery, parity, birthweight, older age, body mass index, levator defect, and a larger levator hiatal area." When it comes to prolapse reoccurring, this systematic review noted that the risk factors are "younger age and preoperative prolapse stage 3 or 4."
McAuley et al. noted that risk factors for overactive bladder, a type of incontinence, are "older age, high body mass index (BMI), low socioeconomic status, diabetes, and smoking." While not necessarily a risk factor, one of the action statements in this study was for constipation management.
Caffeine intake, chronic coughing, diabetes are some of the risk factors for urinary incontinence.
While we cannot modify our age or ethnicity, there are plenty of other risk factors that we can modify.
BMI
This risk factor tends to be a touchy subject with many, especially since BMI was originally meant to be used for a population and not for the individual. There are numerous factors that affect weight loss, including one's comorbidities, so it's not a "one size fits all" type of risk factor. However, even losing 5-10% body weight improves PFD symptoms. Before starting any weight loss program, please consult with your healthcare provider.
Physical Activity
As a physical therapist, I am a big proponent of movement. Something is better than nothing, especially when you are sedentary. Adding more physical activity may help lower your BMI, as well.
The American Heart Association recommends at least 150 minutes per week of moderate intensity or 75 minutes per week of vigorous activity. If you have comorbidities that may interfere with starting up or continuing exercise, find a local physical therapist to help you modify an exercise program to fit your needs.
Physical activity is more than just exercising though. There are three components that make up human energy balance: basal metabolic rate, thermic effect of food, and activity thermogenesis. Activity thermogenesis breaks down even further into exercise and non-exercise. The latter, called Non-Exercise Activity Thermogenesis (NEAT) is the energy you use that is not from eating, exercise, or sleeping. So walking from point A to point B, fidgeting, walking up and down the stairs, performing light and heavy errands around the house, and so on.
It can be difficult to accurately measure the NEAT used by a person in a single day, especially when you are not in a lab setting. There are several factors, however, that affect NEAT levels from one individual to another: age, body composition, education, gender, genetics, occupation, urban environment, and seasonal variations in physical activity. Someone who works in an office is probably not moving as much as a waiter in a busy restaurant, as an example.
But how much energy is used with these activities, in order to get one's bang for their buck? It depends. "Mastication is associated with deviations in energy expenditure of 20% above resting." It was also noted that "very low levels of physical activity, such as fidgeting, can increase energy expenditure above resting levels by 20-40%."
What does this all mean for you? Even if you are not someone who goes to the gym daily, there are other ways to increase physical activity and lower BMI, all without leaving your house potentially.
Chronic Coughing
A cough here or there is not going to have an impactful effect on your pelvic floor. At this point, you might be disagreeing as you leak when you cough. There's a saying I like to use, "You don't notice the first grain of rice on a camel's back, nor the hundredth nor the thousandth. But you'll notice the eight millionth grain of rice on the camel's back when the camel collapses." By the time you are leaking urine with a cough, the camel has collapsed, or at least started to buckle under the weight of all that rice.
A chronic cough can persist for years. Urinary incontinence is a common symptom in women, with "55-66% of women" "reporting it as an issue with a significant impact on their quality of life." 5% of men also reported having the same issue.
There are a range of treatments for a chronic cough, such as medication prescribed from a physician. Coughing increases intra-abdominal pressure. That pressure, like the air in a balloon, is always trying to escape. Our pelvic floor muscles can only deal with that extra pressure for so long before they begin to weaken. This can lead to potential urinary incontinence or a prolapse. If you have a chronic cough, you should consider working with a pelvic physical therapist to keep your pelvic floor strong enough to handle the increased pressure.
Other lifestyle changes someone can make are reduction in caffeine consumption and modifying fluid intake. Managing constipation is another service that pelvic physical therapists can provide.
Age is a risk factor for many PFD, but not a guarantee you'll get it nor of its severity. While there are many risk factors that are modifiable, age is not one of them. PFD is not an inevitable boulder advancing closer and closer with every passing year to flatten you into the ground. You can take the steps needed for your pelvic health.
Alavar Pelvic Health Physical Therapy is offering virtual pelvic health appointments within Nevada. If you live outside of Nevada, we offer virtual coaching sessions.
Ready to book your first appointment?
References:
Levine JA. Non-exercise activity thermogenesis (NEAT). Best Pract Res Clin Endocrinol Metab. 2002;16(4):679-702. doi:10.1053/beem.2002.0227
McAuley, J. Adrienne PT, DPT, MEd1; Mahoney, Amanda T. PT, DPT2; Austin, Mary M. PT, DPT3. Clinical Practice Guidelines: Rehabilitation Interventions for Urgency Urinary Incontinence, Urinary Urgency, and/or Urinary Frequency in Adult Women. Journal of Women's & Pelvic Health Physical Therapy 47(4):p 217-236, October/December 2023. | DOI: 10.1097/JWH.0000000000000286
Morice A, Dicpinigaitis P, McGarvey L, Birring SS. Chronic cough: new insights and future prospects. Eur Respir Rev. 2021;30(162):210127. Published 2021 Nov 30. doi:10.1183/16000617.0127-2021
Rebullido TR, Gómez-Tomás C, Faigenbaum AD, Chulvi-Medrano I. The Prevalence of Urinary Incontinence among Adolescent Female Athletes: A Systematic Review. J Funct Morphol Kinesiol. 2021;6(1):12. Published 2021 Jan 28. doi:10.3390/jfmk6010012
Schulten SFM, Claas-Quax MJ, Weemhoff M, et al. Risk factors for primary pelvic organ prolapse and prolapse recurrence: an updated systematic review and meta-analysis. Am J Obstet Gynecol. 2022;227(2):192-208. doi:10.1016/j.ajog.2022.04.046
Wang B, Chen Y, Zhu X, et al. Global burden and trends of pelvic organ prolapse associated with aging women: An observational trend study from 1990 to 2019. Front Public Health. 2022;10:975829. Published 2022 Sep 15. doi:10.3389/fpubh.2022.975829
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